Healthcare Provider Details

I. General information

NPI: 1316780661
Provider Name (Legal Business Name): MIND BALANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KYLESKU CT
APEX NC
27502-9076
US

IV. Provider business mailing address

4111 ROSE LAKE DR STE E
CHARLOTTE NC
28217-2864
US

V. Phone/Fax

Practice location:
  • Phone: 919-297-8187
  • Fax:
Mailing address:
  • Phone: 919-297-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. COLBY MILLS
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 919-297-8187